Ankle Ligament Damage... please help! :)

First and foremost, may i wish everyone a very Happy Christmas and best wishes for the New Year. Secondly, i would really appreciate some advice on an ankle injury i have been suffering with for almost a year now. I am a PE Teacher (for my sins) and now, all the obese kids can run faster than me!

In January 2012, whilst playing football and jumping to up to challenge for a header, i fell onto my left ankle and sustained immediate pain and swelling which was diagnosed as a soft tissue injury following an X-Ray - revealing no fracture. I was unable to continue playing outfield football, run, swim or cycle. I was on crutches for around 4-5 weeks before i could eventually weight bare. When returning to sport there was immediate pain in my left ankle.

I had 5-7 private physio sessions from April - June and this is was the dianosis given my by physio at the time gave: "At initial assessment demonstrated reduced range of movement globally at the bilateral ankle. Range of movement was particularly restricted into dorsiflexion due to pain over the talocrural joint and lateral malleolus bilaterally. Walking and weightbearing aggravated the symptoms and an altered gait pattern as a result. Effusion was also noted around the lateral ankle, achilles and talocrural joint bilaterally. Our patient has been treated with 6 sessions of aggressive deep soft tissue massage, joint mobilisations and manipulations, ice and heat therapy, and exercise therapy. The patient rested initially and commenced a clinical trial on a bike, with which he reported worsening of pain with one episode on a bike. The client has reported little change following each session of physiotherapy, with little carryover the following week. Walking continues to be affected, with pain worse when using stairs. On examination the effusion is significantly reduced, however symptoms continue to aggravate at the talocrural joint and lateral malleoli bilaterally."

After numerous 'consultations' i was finally put forward for an MRI scan at the end of August 2012. During my 8-10 week waiting period, i went on holiday to Eygpt and on one particular day of travel my left ankle 'ballooned up' and i found it really hard to walk on. Up on my return, my MRI scan revealed there was no significant damage or fractures and when i questioned why my ankle swelled up so much on holiday, the specialist could not give me an answer.

Since September, i have had 4 physio session on the NHS (with 3 different physio's). I have since then had 5 privately paid sessions (with one physio) of aggressive deep soft tissue massage, joint mobilisations and manipulations, ice and heat therapy. I have also worn a brace during this time (Mueller Hg80 Ankle Brace w/Straps). Over the Christmas period i have been given 20 minutes on stationary bike, 10/10 on bike/cross trainer and 20 mins on cross-trainer with ice immediately after exercise and heat treatment there after. I have had no alternative methods of treatment and have been told not to do any exercises (e.g stretching or use of a wobble board which i have looked up in the internet).

My goal this year was to compete in a few Triathlons. This is now my goal for next year.

I'm not the type to write threads but feel like i am going round in circles and would really appreciate some help.

Frim experience rather than any medical background I would say that some form of stablising exercises are missing .. that said, if cycling is making it worse then anything needs to be approached with caution

You have seen a lot of different people, have any of them given you an idea of what the root problem is ?

I'm quite an active person, but activity has been quite minimal this year. As you could probably appreciate, minimal activity is highly frustrating, and even though i've been told not to entertain exercise other than that prescribed by the physio's, i've still tried to jog on a treadmill, managed to muster 2 weeks of cycling to work and back (7 miles each way) during the summer and gone on the rower and cross trainers now and again when i get bored.

After activity there is pain and after physio treatment, my left ankle feels mobile but stiffens up again after 2-3 days. Over the top of my ankle there is a 'sponge' like feeling inbetween the joint, the outside of my left ankle remains really tendon to touch and i cry like a baby during deep tissue massage!

Hi, just going to tell you what my expericences are with injuries which might help you or might not,

First of all I am a 18 year old boy who has been running from year 3 when I started my after school cross country club, so running and sport is in my system, and now I tend to run 10k and half marathons (further the better)

In october 2011, just after I completed my first half marathon, I was out training on the roads and pavements and as I got on back onto the pavement, my right foot landed length ways half on and half off the curb, resulting in me badly twisting my ankle to the point where I could hardly walk, That took me about 4months before I started running again, but before I started runnnig I stayed completely off it, with no exercise (no football, walking etc...) and before I started to run I brought a new pair of running shoes because my thinking is, if I'm going to start running again why not go back to basics with shoes designed for my feet that are completely new meaning my new feet can mold into the new shoes, I slowly built up running again (starting at about a 5k run once a week) and increasing the distance and intensity every week, and I found that going running in the mornings when my body was fresh and not tired from my daily rountine, I also enjoyed doing this more even though it meant going running at 6AM.

By the summer and I had finished college and thought to my-self I going to do nothing other than running (as I don't work it would fill my time) still running in the morning and now doing 3 x 13 mile runs over 5days. This lead to a type of stress fracture in my lower Right Tibia (from internet research it seems quite a common injury). This happened in july and I've only just started exercising again, I think that this was only possible from me completely resting my leg and doing exercises e.g. half raises, walking on just my heels, ankle rotations, and Heat therapy treatment at home, etc...just to strengthen my the bones and muscles around the ankle,

all these things seemed to have worked well in strengthen my ankle and tibia, so it may help you, but remember I'm not a doctor.

p.s. you said you where a P.E. teacher, Do you wear the same shoes you do for P.E. as you do to run and train in?

I have bought myself a new pair of trainers today actually. Will start wearing them as soon as I'm back at work. Asics Gel nimbus 12 (white/gold/black) - they're extremely comfortable and have added support around the ankle. I've worn this make for years and know they are a good pair of trainers. Unless you can recommend another type?

My job means I'm very rarely off my feet. Only time for rest is the evening really.

Compliments of the season to you, with no problem detected with the MRI, and all the treatment you've had, must be very frustrating.... Your symptoms do seem to point to a joint articulation problem - because of the initial injury, one joint may have become hypomobile, while others may have become hypermobile to compensate, creating the irritation and pain. You've said you've had mobilisation and manipulations, but there are DOZENS of joints in the foot (talocrual, talofibula, talocalcaneus and all the midtarsals joints to name a few), it would be interesting to know which ones have been mobilised (and which ones haven't!)

my advice would be when buying shoes (this probably only aplies when your body is still developing and growing) , Don't buy the same make/ Same type of shoes over and over again as your feet will become custom to the shoes which will increase your injury chances.

Why not try an osteopath, who may manipulate the ankle. After damaging the ligaments in my ankle, after physio etc I saw an osteopath who did wonders in tweaking all the tiny joints, it made a difference and I am still running over 10 years later. Runners therapist may be on to something re the joints.

After many years of ankle problems in both feet due to football injuries, mine are currently ok *touch wood*. The best advice I ever got regarding ankle stability & strengthening is to run barefooted on a mini trampoline or trampet, it's very hard work & you can feel all the stabilising muscles working harder than normal, it could be worth a try. I ended up having an ankle ligament reconstruction op long after packing up playing football, I'd ruptured a ligament completely & it was missed in the initial injury diagnosis, I played on for about a dozen years & went over on it regularly to a point where I could hardly walk with spraining it.

Really appreciate different points of view. And again, thank you for taking the time to read my thread.

The Physio I've been seeing for the last 5 weeks suggested a steriod injection as an alternate method of treatment - after the new year. Does anyone have any particular views on this? Or could suggest other methods?

If all the joints in your foot and ankle are moving properly, then a steroid injection is an option - can settle down a inflamed area. (but the problem is it won't take away the cause if it's mechanical)

I can't see it being a ligament problem anymore, they should have healed months ago. Re-strengthening your calf and foot muscles with balance exercises etc, is essential after ligament injuries to regain good ankle proprioception and gait patterns.

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